A Comparison of the Burden of Out-of-Pocket Health Payments in Denmark, Germany and Poland

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It is important to monitor equity of access to health services in all countries. We assessed the levels of out-of-pocket (OOP) health spending in three European countries: Denmark, Germany and Poland. Using data from national databases (i.e., Statistics Denmark, German Socio-Economic Panel, and National Statistical Office of Poland) for the period 2000–2010, we applied common methods to assess the rate of households with ‘catastrophic’ OOP health spending and the concentration of health spending in income-ordered groups of citizens. 20.3 per cent of Polish households experienced ‘catastrophic’ expenditure defined by OOP health spending/income ratio >10 per cent, compared to 1.0 per cent of households in Germany and 3.2 per cent of households in Denmark. 8.8 per cent of Polish households experienced ‘catastrophic’ expenditure defined by OOP health spending/capacity to pay ratio >40 per cent, compared to 0.4 per cent of households in Germany and 0.8 per cent of households in Denmark. Concentration indexes for OOP on drugs in 2010 were 0.01978 and –0.114 for Denmark and Poland, respectively. The rate of households with ‘catastrophic’ OOP expenditure in Poland is much higher than in both Denmark and Germany; health spending in Poland is concentrated among the worst-off groups of citizens while in Denmark and Germany they are distributed more equitably.

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